本文選題：固本瀉濁法 + 慢性腎臟病��； 參考：《中國中醫(yī)科學(xué)院》2017年碩士論文

【摘要】：研究目的:探討慢性腎臟病(Chronic kidney disease,CKD)病程進(jìn)展的影響因素,分析固本瀉濁法與腎功能進(jìn)展的關(guān)系,在此基礎(chǔ)上挖掘張寧教授治療CKD核心處方,為CKD的臨床防治提供理論依據(jù)。研究方法:采用回顧性隊(duì)列研究的方法,選取2014年1月1日至2016年12月31日中國中醫(yī)科學(xué)院望京醫(yī)院所有就診病例(包含門診及住院)實(shí)驗(yàn)室指標(biāo)符合CKD診斷標(biāo)準(zhǔn)(2012KDIGO)的患者670例,最終入組285例。自符合CKD診斷入組開始觀察,記錄基線項(xiàng)目及隨訪項(xiàng)目、終點(diǎn)事件發(fā)生情況,以影響因素為協(xié)變量,生存時(shí)間及終點(diǎn)事件作為應(yīng)變量,進(jìn)行多元逐步Cox回歸模型分析,以探討CKD病程進(jìn)展的影響因素,將固本瀉濁中藥作為影響因素之一,按療程進(jìn)行分層進(jìn)入方程,分析固本瀉濁法辨證治療在延緩CKD進(jìn)展及減少終點(diǎn)事件發(fā)生方面的作用。利用Liquorice軟件以同質(zhì)網(wǎng)絡(luò)創(chuàng)建關(guān)系數(shù)據(jù),導(dǎo)入入組患者觀察期內(nèi)所有張寧教授門診處方信息,挖掘藥物之間的核心配伍關(guān)系,經(jīng)張寧教授確認(rèn),得到治療CKD的核心處方。研究結(jié)果:1.基線特征:本研究中共納入研究對(duì)象285例,平均基線年齡為68.98歲,其中男性51.6%,中位隨訪時(shí)間為230d,基線eGFR分期情況:CKD3期(41.7%),2 期(19.3%),1 期(16%),4 期(14%),5 期(8.8%),CKD～3 期的研究對(duì)象 77.2%。2.終點(diǎn)事件發(fā)生情況:285例隨訪研究對(duì)象共57例進(jìn)入終點(diǎn)事件。其中主要終點(diǎn)事件31例:包括死亡19例,腎臟替代治療6例,進(jìn)入CKD5期6例。次要終點(diǎn)事件26例:其中10例為eGFR較基線下降≥25%,且GFR分期改變,16例為ACR分期進(jìn)展。未觀察到CKD快速進(jìn)展。3.全部終點(diǎn)事件Cox回歸分析結(jié)果:基于單因素分析結(jié)果:年齡,高磷血癥、低鈉血癥、貧血、AKI、AKD(非AKI)是全部終點(diǎn)事件的危險(xiǎn)因素,而固本瀉濁治療為保護(hù)性因素。而在多因素分析中仍然顯著的影響因素是:高磷血癥和CKD基礎(chǔ)上的AKD(非AKI)。按中藥治療療程分層,繪制生存曲線,根據(jù)生存曲線的結(jié)果,服用中藥的療程對(duì)患者的近期和遠(yuǎn)期的生存時(shí)間(出現(xiàn)終點(diǎn)事件之前的時(shí)間)均有影響,且未服用中藥組的生存曲線較低。在近期生存曲線中,未服用中藥的患者相比于服用中藥的患者,生存時(shí)間較短,而服用中藥不同療程的患者中,近期生存時(shí)間差別不顯著。在遠(yuǎn)期生存時(shí)間中,服用中藥半年及以上的患者生存曲線平直,且明顯高于其他療程的患者。4.主要終點(diǎn)事件(死亡+腎替代治療+進(jìn)入CKD期)Cox回歸分析結(jié)果:基于單因素分析結(jié)果:基線eGFR分期、貧血、高磷血癥、低鈉血癥、AKI、AKD(非AKI)是主要終點(diǎn)事件的危險(xiǎn)因素,固本瀉濁治療仍為保護(hù)性因素,但未達(dá)到顯著性水平。在多因素分析仍然顯著的影響因素為:高磷血癥和CKD基礎(chǔ)上發(fā)生AKD(非 AKI)。5.基于復(fù)雜網(wǎng)絡(luò)分析挖掘張寧教授治療CKD的核心處方為:黃芪、柴胡、石韋、白茅根、茯苓、丹參、生薏苡仁、當(dāng)歸、地龍、白芍、炒酸棗仁,酒大黃。結(jié)論:1.高磷血癥及AKD是CKD病程進(jìn)展的獨(dú)立危險(xiǎn)因素。2.固本瀉濁法辨證治療能夠在一定程度上延緩CKD病程進(jìn)展。3.基于復(fù)雜網(wǎng)絡(luò)分析挖掘張寧教授治療CKD核心處方有助于總結(jié)和繼承老師治療CKD的學(xué)術(shù)思想。
[Abstract]:Objective: To explore the influencing factors of the progression of Chronic kidney disease (CKD), and to analyze the relationship between the method of purging turbid and the progression of renal function. On this basis, we excavate professor Zhang Ning's core prescription for the treatment of CKD and provide a theoretical basis for the clinical prevention and treatment of CKD. Methods of retrospective cohort study were used to select 1 2014. From 1 to December 31, 2016, all the cases (including outpatient and hospitalization) in Wangjing Hospital of China Academy of traditional Chinese medicine (including outpatient and hospitalization) were in accordance with the CKD diagnostic criteria (2012KDIGO), and the final entry group was 285 cases. The baseline and follow-up items were recorded from the CKD diagnosis group. The covariance volume, the survival time and the endpoint event were used as the variable, and the multivariate stepwise Cox regression model was used to analyze the influencing factors of the progress of the course of CKD disease. The traditional Chinese medicine was taken as one of the influencing factors, and the treatment was stratified into the equation according to the course of treatment, and the treatment of syndrome differentiation and treatment was analyzed to delay the progress of CKD and reduce the occurrence of endpoint events. Using the Liquorice software to create the relational data with the homogeneity network, import all Zhang Ning outpatient prescription information in the observation period of the group, excavate the core compatibility between the drugs, and get the core prescription for the treatment of CKD by Professor Zhang Ning. The results of the study: 1. basic line features: this study included 285 cases, average of the research subjects. The baseline age was 68.98 years, of which 51.6% were male, median follow-up time was 230d, and baseline eGFR staging: CKD3 (41.7%), 2 (19.3%), 1 (16%), 4 phase (14%), 5 phase (8.8%), CKD ~ 3, 77.2%.2. terminal events. 19 cases of death, 6 cases of renal replacement therapy, 6 cases of CKD5 stage, 26 cases of secondary end point event: 10 cases of eGFR compared with baseline decrease of 25%, GFR stage change, and 16 cases of ACR staging. The Cox regression analysis of CKD rapid progression.3. terminal event was not observed: Based on single factor analysis, age, hyperphosphatemia, hyponremia, poor, poor, poor Blood, AKI, and AKD (non AKI) are the risk factors of all endpoint events, and the treatment of purging turbid is a protective factor. In the multifactor analysis, the significant factors are the AKD (non AKI) based on hyperphosphatemia and CKD. According to the treatment course of Chinese medicine, the survival curve is drawn. According to the result of the survival curve, the treatment course of Chinese medicine to the patient In the short term survival curve, the patients who did not take Chinese medicine had a shorter survival time than those taking traditional Chinese medicine in the short term survival curve, but the difference of the short-term survival time was not significant in the patients who took traditional Chinese medicine without the same course of treatment. In the long term survival time, the survival curve of patients taking Chinese medicine for half a year or more was straight, and obviously higher than the results of Cox regression analysis of.4. main endpoints (Death + renal replacement therapy + entering CKD) in other courses: Based on single factor analysis, baseline eGFR staging, anemia, hyperphosphatemia, hyponatremia, AKI, and AKD (non AKI) were the main factors The risk factors of endpoint events were still a protective factor, but there was no significant level. The significant factors in multifactor analysis were: hyperphosphatemia and CKD based AKD (non AKI).5. based on the complex network analysis of Professor Zhang Ning's core prescription for the treatment of CKD: Astragalus, bupleurum, shivido, root, porch. Conclusion: 1. hyperphosphatemia and AKD are independent risk factors for the progression of CKD's course of disease,.2. fixation and turbidity method can postpone the progression of CKD to a certain extent.3. based on the complex network analysis of Professor Zhang Ning's treatment of CKD core prescription helps to summarize and inherit The teacher treats the academic thought of CKD.
【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R277.5

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